What is the referral route for weight loss surgery in Glasgow?

Attending and completing the GCSWMS programme is the only way to be referred for weight loss surgery in the NHS Greater Glasgow and Clyde area.

Occasionally someone may be considered for surgery outside of this if they have extraordinary health or clinical issues which would be improved by weight loss surgery. This would be considered following a discussion with the patients own health professionals and the exceptional referral to surgery group.

What type of surgery is offered?

Laparascopic Gastric banding surgery and gastric sleeve are the two types of bariatric surgery offered in NHS Greater Glasgow and Clyde.

What are the criteria for weight loss surgery in NHSGGC?

If you are attending the Glasgow and Clyde Specialist Weight Management Programme our staff can talk to you about surgery and who is suitable.

A referral for weight loss surgery will be considered when:

Diagnosis of Type 2 diabetes < 5 years

Less than < 45 years of age

BMI 35 > < 50 kg/m2

HbA1c < 75mol/mmol

Completion of Lifestyle Programme

Loss of at least 5 kgs

The surgeon will make the final decision

Your BMI is a calculation that shows if your weight is in the healthy range for your height.

You can check what your BMI is on our website by clicking on Referral and Check your BMI.

How are people referred for surgery?

If you meet criteria 1, 2 and 3, you will be informed at initial assessment and invited to a Surgery Information Session ( SIS) when you opt into the program.

Surgery Information Session

The patient is invited to a Surgery Information Session where the Surgery Team will explain:

What gastric band and gastric sleeve surgery is and how it helps people to lose weight.

What to expect from gastric band and gastric sleeve surgery, including expected weight loss.

When surgery may not be the most suitable treatment option.

The areas that surgery will not help with and that the patient will need to work on (with the help of GCSMWS team).

That they must attend at least Phase 1 of the programme

That they will need to lose 5 kgs weight

The need to maintain their blood sugar levels at <75mol/mmol

You can ask questions at the Information Session and are encouraged to consider which surgery is the right choice for you.

Written information will be given and you can bring a friend or relative to the session.

You do not need to make up your mind at this point and are free to attend the SIS again and enter the surgery programme at any time in the programme after you have completed Phase 1 and continue to maintain at least 5kg weight loss.

If you do decide to opt for surgery you then enter the surgery pathway as outlined below

What does the Surgery assessment involve?

Psychology Assessment

The Surgery Team psychologist will carry out an assessment with the patient. This will look at areas such as:

Level of psychological, social and cognitive function (these things will be explained by the psychologist)

The psychologist will then discuss some of the information gathered with the dietitian. The psychologist will advise if any psychology support or treatment would be needed for the patient before surgery. The psychologist will also consider whether the patient is suitable to move on with the GCSWMS surgery pathway.

The patient will then be seen for assessment by the surgery team dietitian.

Dietetic Assessment

The dietitian will look at areas such as:

· The diet changes the patient has made so far

· Current meal pattern and eating routine

· Current portion sizes

· Current physical activity levels

· Eating habits that the patient thinks gastric surgery will help them improve.

As part of the assessment the Surgery team will ask the patient to follow a two weeklow calorie trial diet. This is to show that the patient can make the changes to their diet and behaviour that will be needed to achieve success after weight loss surgery.

What happens next?

If the psychologist and Dietitian feel that the patient is suitable to be put forward to the surgeons they will send a referral report to the surgeons.

The surgeon will then see the patient and assess if they are suitable for surgery.

It is the surgeon who makes the final decision on surgery.

Their decision will be based on clinical risk and also the patient’s history with managing their weight.

How does the GCSWMS Surgery team prepare people for weight loss surgery?

It is very important that a patient who has weight loss surgery is given the right advice and support before and after their surgery. This gives people the best chance of success.

To help patients prepare for surgery they will be asked to attend Preparation forSurgery groups at GCSWMS. Patients will be given information about this after the dietitian and psychologist have agreed for the patient’s referral to move forward to the surgeons.

The Preparation for Surgery groups run fortnightly for 4 sessions and their purpose is to help patients prepare as best as possible for surgery and life after.

In these groups patients will be given advice on:

Dietary changes

Eating behaviours and emotions

Physical Activity

Patients will be given support to find changes they might need to make in some of the above areas – making these changes will help patients have successful weight loss after surgery.

One to one support before surgery

Just before their operation patients will be seen one to one to be given diet advice. Patients will also be seen by the GCSWMS Surgery Team 4 weeks after they have had their operation.

Patients might also be seen by the surgery team psychologist in the lead up to surgery. The surgery team psychologist would decide if this support was needed.

Patients can also be seen by the surgery team physiotherapist at this time for advice about activity or mobility issues, if needed.

When patients are seen by the GCSWMS surgery team just before surgery they will be given dates for GCSWMS Surgery Support groups (there is more information on the Surgery Support groups below).

Where do patients have their surgery?

The surgery is carried out at: Queen Elizabeth Hospital or Glasgow Royal Infirmary.

Can people who have been through the GCSWMS Weight Management programme be referred again directly for surgery?

No.

For example:

A patient has been through the Weight Management Programme and finished it. They were discharged in January 2011.

The patient is referred back to GCSWMS and rejoins the service in February 2012.

This patient would need to attend the GCSWMS programme again in 2012 and complete it, after this a referral to the Surgery Team could be discussed if suitable.

This is because it is important to have the correct lifestyle and behaviour changes in place before moving on with surgery and for patients to continue to build on changes they have made.

How much weight loss can be expected following gastric banding surgery?

It has been shown that over the first two years after surgery someone can lose 50%(band) or 60% (sleeve) of the excess body weight they are carrying on average.

In the first two years after surgery this patient could lose half of their extra weight (half of 90kg)

= This patient could lose 45kg (7 stones 1 pound) in the first two years after surgery

If they lost 45kg their weight would be 125kg and their BMI would be 39 (kg/m²)

How much weight a patient loses completely depends on how much they make changes to their diet, exercise levels and behaviour. Some patients can lose more weight than this; other patients may lose less weight.

What follow-up support is offered?

GCSWMS offers lifelong follow up after surgery.

Getting follow up and support is a very important part of success after surgery.

GCSWMS offer patients follow up appointments regularly. Patients are seen by the surgery team dietitian:

1 week after surgery (telephone contact)

4 weeks after surgery

8 weeks after surgery

… then moving at three months, to the Post surgery support groups

Post Surgery Group

Patients are supported in groups covering all aspects of living with their surgery. The focus is on correct nutrition, exercise, social and psychological aspects of life with bariatric surgery

If it is needed patients may also be seen by the surgery team psychologist after surgery. This can be long term support.

Patients can also be seen for physiotherapy support at this time if needed.

We also run monthly Surgery Support groups.

This is a chance for surgery patients to meet and discuss their progress and issues. Patients at the support groups could all be at different stages with their surgery. For example, some people may recently have had their surgery and others a number of years ago.

Patients who have not yet had surgery might also be invited to attend a support group to listen to the discussions and learn more about the surgery.

At the Support Groups patients might:

Share the lifestyle changes they have made

Talk about how to cope with difficult situations that might affect weight loss

Offer each other advice and support

Overall, the Surgery team at GCSWMS hope to offer people the support they need in areas where they need it (diet, activity and psychology).

We want to help people build the skills they need for making lifestyle change and we hope to support people with losing weight and maintaining weight loss for the long term.